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Have you reached your Medicare Safety Net Threshold?

Having to pay a lot for your healthcare? You might be about to hit the Medicare Safety Net Threshold.

Medicare Safety Net Thresholds kick in after you spend a certain amount on out-of-hospital healthcare (such as GP or specialist visits) and help to reduce your costs for the remainder of the year. This means you’ll get more money back (up to 80%) from the government for certain Medicare services.

What costs does this include?

The threshold only relates to eligible health services where you have paid for the service out-of-pocket. Most GP services count towards your threshold calculation, but you will need to have paid a gap. For example, if your GP bulk-bills your consult, it won’t count towards you reaching the threshold. However, if we charge you for your consult, the difference between what you pay and what you get back from Medicare as a standard rebate (i.e., your ‘gap’) will count. It might look like this –

You attend a consult with a GP and are charged $90 for a standard consult (23). This attracts a standard Medicare rebate of $39.10, meaning your out-of-pocket cost (or gap) is $50.80. $50.80 is added to your threshold calculation.

Once you reach the threshold, you will start getting 80% of all your out-of-pocket expenses back for all eligible out-of-hospital medical appointments and diagnostic tests.

What is the threshold amount?

The threshold amount depends on whether or not you have a concession card. Families are also able to combine their out-of-pocket expenses. The threshold is calculated every calendar year, refreshing on Jan 1.

Concession cards include: Pension cards, Commonwealth Seniors cards, and Health Care cards.

Thresholds Who’s it for? Threshold Amount What counts towards the threshold? What benefit will I get back?
Extended Medicare Safety Net (EMSN) – General Everyone in Medicare $2,249.80 Out of pocket amounts for the calendar year 80% of out-of-pocket costs
Extended Medicare Safety Net (EMSN) – Concessional and Family Tax Benefit Part A

 

Concession card holders and families eligible for Family Tax Benefit Part A $717.90 Out of pocket amounts for the calendar year 80% of out-of-pocket costs

 

How do I know if I have reached the threshold?

For individuals, the system will automatically identify you as having reached the threshold and you will automatically be allocated the higher rebate. We can tell you when you have reached the threshold, but we won’t know until we put a payment through.

For families, you will need to make sure you link your individual accounts together in order to combine your healthcare expenses. You will need to go onto MyGov to do this. Families can often reach the threshold faster as there are multiple people combining their out-of-pocket costs.

For more information, visit the Services Australia website.